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NPI Code Detail

MEDICARE: LOUISA NICOLE CALVERT SLP

MEDICARE: LOUISA NICOLE CALVERT SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist3410OK

General Provider Information

NPI Number : 1831496256
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOUISA NICOLE CALVERT SLP
Provider Business Mailing Address
First Line : 1405 4TH AVE NW # 296
Second Line :
City : ARDMORE
State : OK
Zip : 73401-2708
Country : US
Telephone Number : 580-795-4561
Fax Number :
Provider Business Practice Location Address
First Line : 3701 N MARTIN LUTHER KING JR BLVD
Second Line :
City : TULSA
State : OK
Zip : 74106-6450
Country : US
Telephone Number : 918-425-8932
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2011
Last Update Date : 04/15/2015

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Directions to “ LOUISA NICOLE CALVERT SLP” Practice Location

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